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題 名 | 大腸結核病之內視鏡診斷及臨床分析=Endoscopic Diagnosis and Clinical Experience off Colonic Tuberculosis |
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作 者 | 林淳榮; 吳正雄; 陳邦基; 郭佑啟; 張耿源; 吳錫賢; 董水義; | 書刊名 | 長庚醫學 |
卷 期 | 19:4 1996.12[民85.12] |
頁 次 | 頁298-304 |
分類號 | 415.5091 |
關鍵詞 | 大腸結核病; 抗酸性桿菌; 乾酪性肉芽腫; 大腸內視鏡; Colonic tuberculosis; Acid fast bacilli; Caseous granuloma; Colonoscopy; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:肺結核在臺灣地區雖已受控制,但胃腸道結核仍零星可見。大腸結核病以往因臨床表現多樣,多需藉手術後病理及細菌學確定診斷。文獻中以大腸內視鏡併切片檢查之報告已近二十年,但診斷陽性率差異頗大。 方法:本院從1979年2月至1994年5月止,共有18例經病理或臨床診斷為大腸結核病患者,且全部接受大腸內視鏡檢查、胸部X光及痰液結核菌培養,並有臨床追[]治療。 結果:有10例男性,8例女性,平均年齡為43.6歲。臨床症狀依次為腹痛(83%),腹瀉(67%),體重減輕(61%)。發病至診斷的時間平均為4.1個月。胸部X光檢查18例中有14例(78%)發現活動性或陳舊性肺結核病灶,其中4例成粟粒性肺結核,痰液結核菌培養有8例呈陽性。大腸內視鏡檢查得病發部位以迴盲部6例(33%),迴盲部及侵襲至其他結腸者8例(44%),不侵犯迴盲部之節段式大腸結核有4例(22%)。內視鏡表徵包括多發性潰瘍(44%),肥厚增生併潰瘍(28%),息肉樣增生(11%),腸狹窄(11%),非特異性腸炎(6%)。14例施行活體切片時,僅5例具乾酪性肉芽腫,其中2例AFB染色陽性。另5例疑似盲腸腫瘤,開刀後方經病理證實。其餘8例因有肺結核病灶,給予嘗試治療。所有病例(包括開刀例)皆接受抗結核藥物治療而症狀漸緩解甚至消失,僅2例因腸阻塞併發症接受開刀,但無死亡例。 結論:(1)迴盲部腫瘤或潰瘍應將大腸結核病列為鑑別診斷。(2)本地患有慢性腹部症狀且具肺結核病史者,建議接受大腸內視鏡併切片檢查,以利早期治療。(3)治療以抗結核藥物為主,對疑似病例可嘗試用藥,避免不必要的手術與併發症。 |
英文摘要 | From Feburary 1979 to May 1994, 18 cases of colonic tuberculosis were detected by colonscopy at Chang Gung Momorial Hopistal, Linkou Medical Center. There were 10 males and 8 females, with mean age of 43.6. In ten, the diagnosis was confirmed histologically or bacteriologically in colonic biopsy material and post-operated lymph nodes. The remaining 8 patients was suspected on colonoscopy, and had good response to antituberculous therapy. The major symptoms were abdominal pain (83%), diarrhea (67%), and body weight loss (61%). Average duration from symptoms to diagnosis was 4.1 months. Chest X-ray revealed active pulmonary tuberculosis in 14 of 18 patients (78%), 4 of 14 patients were miliary type. The colonic tuberculosis involved in ileocecal area in 6, ileocecum and contiguous colonic regions in 7, segmental colonic involvement in 4, and pancolitis in 1 patient. Multiple ulceration and ulcerohypertrophic lesions were the major colonoscopic findings. Typical caseating granuloma were found in 5 cases (36%) from colonscopic biopsy, the other 5 from surgical resected specimens. Antituberculous therapy produced remarkable symptomatic improvement in all patients except 2 cases complicated with intestinal obstruction necessitating laparotomy. Colonoscopy with biopsy is a useful diagnostic tool in early diagnosis and avoiding unnecessary laparotomy in colonic tuberculosis. |
本系統中英文摘要資訊取自各篇刊載內容。